A 5-year-old boy suffered a stab wound to the back in the right paraspinal region that resulted in spinal cord injury at T2-T3 level and spinal shock. Bilateral paresis was present in lower limbs, absent superficial reflexes, retention of urine, and loss of bowel and bladder sensation. After methylprednisolone, normal saline, and phenylephrine for hypotension, his condition improved and exam at 8 days revealed spastic paresis of the right lower limb, absent vibration and position sensation below the nipple level on the right side, and loss of pinprick and temperature sensation in the left half of the body. He also had paralytic ileus, constipation, and loss of bowel sensation. A clinical diagnosis of incomplete spinal cord injury at T4 dermatome and Brown-Sequard-plus syndrome was confirmed by MRI. At 6 weeks he was weaned off vasopressor agents and he had partial recovery of power in the right lower limb and full recovery of sensations. [1]
COMMENT. Incomplete spinal cord injury and Brown-Sequard syndrome are adult disorders, but motor vehicle accidents and violence may be responsible in children. The authors cite 3 additional pediatric cases reported in the literature. High-dose steroids in 2 cases (including the present case) and surgery in 2 resulted in good to complete recovery.